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Archive for the ‘Sleep Apnea’ Category

Fitness is an important part of change in a person’s health. In order to decrease injury and to get the ideal benefit to your hard work proper sleep is necessary. When you exert your body it is important for your recovery to make sure you are getting enough sleep.

During the night you go through different stages of sleep. Your body goes through different stages of sleep throughout the night. During the first third of the night we go into slow wave sleep. This is the time of sleep where we repair our body. The most essential part of recovery after an especially hard work out is the time for our muscles to heal and grow.

In order to take advantage of the best stages of sleep for your needs you need to create a routine that meets them. Since you want to take advantage of the healing time you have to plan to fall asleep rather early. To do this you need to plan ways to unwind before you go to bed. Practicing deep diaphragmatic breathing is a great way to help gear your body to unwind. By doing these exercise 6 to 10 breathes a night you will recruit airways you do not usually use and will increase the level of oxygen available to your body.
The best way to do diaphragmatic breathing is to lie down and place your hands at the bottom of the rib cage. You want to fill your lungs by pushing your hands out. You want to take this breath in slowly. At the top of the breath you want to hold it for 2 counts which will allow you to equalize pressure throughout the lung including the less used areas. Then you slowly exhale through pursed lips. That slight back pressure helps to keep those airways open. If you have need for those airways they are easier to get access to when I need that extra big breath during a run or when you are lifting.

You also need to take advantage of light and dark. Our body really does run on light and dark and the excess light especially prior to sleep will make it very difficult to fall also and you might miss some important slow wave sleep. So turning off light producing product 30 minutes before going to bed will be helpful. In younger athletes helping them to develop the ability to sleep without electronics will help them to grow, heal and be strong.
Ending your sleep too soon robs your brain of the chance to go into REM. During this period of sleep our short-term memory shifts to long-term memory. This is essential and is more productive than cramming for a test or big presentation. Getting the proper amount of sleep allows your brain to process all the information and make it easier to get access to when you need it. When you are sleep deprived because you have missed stages of sleep.

Ultimately being athletic is a combination of proper nutrition, exercise and rest. Because there are much more specific needs that can lead to injury being aware of your sleep and your physical need which may be more than the average person your age due to the need for healing. Do not skim on this because the side effects of sleep deprivation will decrease your ability to compete the way you want to.

Shaquille O’Neal recently let the world know he has sleep apnea. He shared his experience of testing and treating it with the world on You Tube. A month later he is announcing his retirement from professional sports. Is it possible that the long term effects of sleep apnea have caused him to feel he has come to the end of his career sooner than he could have? Did his poor sleep from traveling and changing time zones add to the problems he was already having?

Sleep is important to everyone but for an athlete it is an essential part of training. Getting slow wave sleep is where the body releases its growth hormone and heals itself. This deep sleep occurs during the first third of the night. If, like Shaq, you stop breathing 20-39 times an hour it becomes impossible for the body to reach this portion of sleep. Add to the inability the stress of his oxygen dropping throughout the night so he is unable to give enough oxygen to his muscles and you do not get fed. Finally add the stress all this lack of sleep on the body as a whole will keep his body from healing properly.

Shaq also lived a life that kept him from having good sleep hygiene. Traveling and the constant change of time would cause issues with his ability to go to sleep and wake up. The body works best when it has a routine and with constant changes not only of time but also the light that stimulates the brain to help regulate the body rhythm can make the brains ability to shut down difficult.

If Shaq had actually treated his sleep apnea earlier it might have helped improve his health significantly. As this stress works on the body it contributes to high blood pressure, diabetes, heart disease, stroke, and current research has even linked it to certain types of cancer. The body needs rest to recover and it needs rest to reboot our brain and help with our short term memory. When we do not get this solid rest we pay a price with out health. Although Shaq has played professional ball for 19 years he may have been able to go that 20th season if he had just rested a little better.

What lessons can we learn from this in our own lives? We should listen to our bodies. Snoring and fatigue are not normal. They are signs that should be listened to and discussed with your doctor. If you live alone and do not know if you snore but have other health issues such as high blood pressure or diabetes that are not improving even on medication you might want to ask your doctor about sleep apnea. You might also think that sleep apnea is just for those who are overweight, this is not the case. You can be any size or shape and have sleep apnea. It is more about how your airway is built then how much fat you carry on your body.

Overall sleep is important to your health and if you get a good night sleep each night you will find that your health and your energy levels should improve.

CPAP therapy is considered the gold standard for treating sleep apnea. It is a machine that uses a mask of some type to deliver a specific pressure of air to help keep the airway open. The problem with CPAP therapy is that it does take getting used to in order to be successful in using it nightly. There are some very specific reasons that people fail to be able to adjust to it and there a definitely ways to overcome these obstacles to be successful and feel better.

1. There is a lack of communication. Many patients are afraid they are disturbing someone if they call when they are having issues with their CPAP. The truth is that if you want to be successful using your machine you need to communicate your issues with a professional. Depending on who you are working with you should call your doctor, the company that set up the machine or the sleep lab who performed your study. There can be many issues but if no one knows you are having problems then the problem can not be fixed.
2. You have the wrong mask. If you had a sleep study where they fit you with a mask you must remember that you were only there for a short time. A mask might seem right during the study but may not fit as well at home. You may also find that although the mask is good the first couple of night after wearing it for a week it may not be as comfortable. In most cases insurance will pay for a change of mask during the first 2-4 weeks after your machine is delivered. This may not be true for those who have an HMO where the insurance company may dictate which mask you are given. In those cases it may benefit you to purchase a mask that might fit you better. It may cost you but it will be worth it in the end. Also those who have sensitive spots from the mask may benefit from having two masks to rotate through to change the pressure point.
3. You do not use the humidifier. Many patients think that the humidifier is an optional piece of equipment but it is not. It is essential that you use the humidifier and that you set it to the appropriate setting. In the winter you will need more humidification then during the summer due to the air being dryer. If you do not get enough humidity you will find your mouth, nose and sinuses will get sore, swollen. You may also find that you will develop a stuffy nose due to the welling of the nasal tissue and the increase of mucus being secreted to deal with it.
4. The pressure is too high or too low. The goal of the sleep lab is to find the lowest pressure needed to eliminate most of your respiratory events. However, just because they achieved a final pressure does not mean that it is the best pressure for you. Remember you are only in the sleep lab for one night and it is not the optimal sleep conditions. You are wearing wires, sleeping in a strange bed and it is usually the first time you have ever tried on a CPAP mask. The pressure achieved may be a little high or a little low. It may be that you need a higher pressure then you can handle. No matter what the issue there are certain procedures that must be followed before lowering the pressure. You will probably be asked to try a different mask. This is to see if the issue is not pressure but comfort. You may then have to see the sleep specialist before he is willing to turn you pressure down. This is because he is ultimately responsible for making sure your care is the best you can receive.
5. You did not give yourself enough time. This is long term therapy. That means you will be using this equipment for a long time. So give yourself a little time to get used to it. For the first few days if you feel uncomfortable wearing it at night. Put it on while you are sitting in your recliner in the living room. Wear it for about an hour. Get used to it. Then increase your time wearing it. Usually be the end of the first one or two weeks you should be ready to sleep with it.

CPAP therapy is an important part of keeping you healthy if you have sleep apnea. Giving up before you give the therapy some time will do nothing to improve your health and in the long run can have very serious consequences. Remember your doctor and the people who have worked with you want you to be successful.

If you are just starting out as a new CPAP user you will find that a little support goes a long way. Family support is important but it is support from other users that will truly allow you to find what will work for you. The problem is that most physician’s offices and DME companies do not tell you where to find support. But if you look online and in your community there are some great support groups.

Local Support GroupsThe American Sleep Association is an excellent resource for finding local support groups. They are the association that started the A.W.A.K.E. groups. They have even started on online meeting for truck drivers since they have unique issues such as repeated testing and traveling with their machine. Their website sleepapnea.org also has up to date research, and an online forum to have questions answered. If there is not a support group near you then they will help you start one up.

Online Support GroupsTalkaboutsleep.com was started by a sleep apnea patient who felt she needed more support. The site has a chat room, message board and strong basic information about sleep disorders. The most interesting part of the site is the reviews of equipment and the comparisons of the masks. Once a quarter they will trial two similar masks from different manufacturers. They send samples to members to trial and then review. This gives people the opportunity to hear what actual patients think of new masks when they come out. They also have an excellent store to buy masks and accessories for your machine.

Sleepguide.com is a message board for sleep patients. There are patients and health care professionals who frequent the site and answer each others questions. You will find many opinions from different sources.

Physician SitesDrStevenPark.com is a great resource. He has monthly webinar that answers pre-submitted questions on CPAP and sleep disorders. His site has interviews with other healthcare professionals and medical articles. He also has a book for sale called Sleep Interrupted.

About.com has a page on sleep disorders that is written by Dr. Brandon Peters. He has a weekly newsletter that covers basic topics such as what is sleep apnea and new treatment options. Everything he has written is archived on the website so you are able to look up specific topics or disorders. This site covers many sleep disorders including Restless Leg Syndrome, REM Behavior Disorder ad Sleep Talking to name a few.

Seeking Help is the Key
If you are starting out with CPAP these sites and groups will help you to understand you are not alone. It will also help you to overcome problems that might arise while you get used to the new therapy. The more educated you are about your disorder and the more support you seek the more successful you will be.

Technology has come a long was and studying sleep is no exception. We are now able to perform sleep studies in the home as well as the sleep lab. This is a great thing because it allows more people to be tested for sleep disorders then every before. The drawback is that there are limitations to what can be done in the home versus the lab.

In home sleep studies are generally modified unsupervised sleep studies. This means that the equipment is delivered to the patient and then they are responsible for applying it and taking it off. In some areas a technician will come out in the evening to apply the equipment and you will wear it the rest of the night, then you may have to take it off or the technician will come back in the morning and remove it. Generally these types of studies are limited in nature and only monitors certain parameters, oxygen level, heart rate, breathing, and whether you are awake or sleep and position. Because the study is limited it is designed strictly to diagnoses sleep apnea. Other conditions a person may have will not be diagnosed, such a periodic limb movement disorder and teeth grinding. This type of testing is also not good for patient with significant health issues such as congestive heart failure or COPD.

In lab testing has several differences. The first one is there is a technician there with you if any problems should arise. If one of the wires become dislodged it can be fixed right away. You do not need to have another study performed. The technician is also there to answer questions should you have any during the nights. The most important role of the technician, however, is that they can intervene if there is a significant health issue during the night. They can also do a special type of study called a split night, or combination study, which allows you to be diagnosed and treated for your sleep apnea on the same night. This way if you have severe sleep apnea you can be treated right away instead of waiting. You also are able to be evaluated for other conditions you may not know you had.

Treating sleep apnea after the home sleep study can occur in two different ways as well. You can be brought into the sleep lab for a titration study. During this test the technician finds a mask that works for you, educates you about CPAP and how it works and then finds the right pressure to eliminate most of the apneas and snoring. This test also allows the doctor to look for the other disorders such as periodic limb movements.

The other option for treatment is to have a homecare company deliver an auto-titrating CPAP. This machine is set to allow a range in pressure that adjusts as you have events during the night. The technician will fit you for a mask and then leave the machine for you to use. The drawback is that there is no one there during that first night to assist you if there is an issue. The other issue is that unless you call your doctor or the company that delivered the machine they may not be able to correct any problems that happen until they download the information in the CPAP memory.

Overall home sleep studies do have a place in the diagnosis and treatment of sleep apnea. They are very good for diagnosing the straight forward sleep apnea patient. If, however, there is any issues that need to be addressed right away or if a person needs some assistance this may not be the best choice. A full sleep study allows for the possibility for quicker treatment and intervention. There is also the ability to diagnose other conditions that might go unnoticed in the home setting. That and the personal care involved in testing help to create a successful long term care situation.

An article was released about teens and the effects of caffeine and technology is having an effect of teens and their sleep. I know I live this issue daily. I have a teen son and a daughter who is just in her 20s. The problem is that we have not created a culture that supports teens and their needs.

This article was timely as this week my son took his yearly standardized tests. He has to get up at 6am to get ready for school so he can arrive just before 7am. He will then sit in the testing room he is assigned to and will take a test that will decide his future. Of course what they are not thinking about as these students enter the school is that more than half of the students walk on campus with an energy drink, diet soda or Starbucks in their hand. They are all yawning, dragging their feet and look like they could use two more hours of sleep. When they normally attend class at least 3-4 of the students will want to put their head down during at the very least 1 period. These are not fresh, excited students. These are sleep deprived people who our culture is trying to get to fit into a cheapest easiest way to give them an education. We have not created an education that is designed for them to become successful educated people that can perform at their optimum.

Add to this early more education some new parts to our culture. Their diets include processed food, chemical substances, and stimulants like caffeine. They are exposed to light 24 hours a day and their brains are stimulated from the time they wake up until the time they go to bed. They are in the computer, playing video games or watching television. They have 2-3 hours of homework they need to do when they come home. They also have outside activities. Things like my son’s Boy Scout meeting will last from 7-10:30 at night. We have not set them up for optimal sleep we have set them up to be sleep deprived.

It is difficult to tell a 5’10” boy that it is bed time at 9 or 10 pm. The world has not stopped or even slowed down by then. He still has homework he wants to tweak, friends to chat with or challenge on a game, or just wants to watch a show he knows everyone will be talking about at school the next day. He gets tired around 11-12pm and is sound asleep no later than 1am. On the weekend he sleeps until 11am and sometimes a little longer. His friends are the same way.

I believe that we have to look at what our children need, how to create a healthy environment for them and then nurture that. Is sending our children to school at 7am really in their best interest? One of the local school districts changed the time for the high school children from 7 to 9. Next year they are changing it back because it interferes with after school work and activities. Did they even bother to look at the student’s attendance, grades or test results? They did not.

So what is the result of sleep deprivation with our teens? It is multifold, sleep deprivation can increase the incidence of depression, increase the symptoms of ADD, increase the chances of obesity. It interferes with learning and storing information into long-term memory.

Now we need to explain to our teens why a sleep routine, turning off all electronics and going to bed early I so important. We need to overcome peer pressure so that our children understand that this is the norm. We need to be examples for them. We need a very strong sleep routine that includes turning off the computer and the television. We need to make time for the family to sit and eat together and read together. These changes will help them during the tough teen years. We need to help them reach their true potential.

Your wife or husband tell you they need to go to bed before you or they will never sleep. You know if you are going on a trip you can not share a room with anyone else because they will complain. Do you know when a snore is something you need help for or just annoying?

The fact is that no matter what a snore is not normal. If you snore there is something in your anatomy that says you need to have it evaluated. It may be just that you have a large uvula that vibrates when you breath at night. It could also mean you have sleep apnea, a condition where you stop breathing or breathing is partially obstructed and your oxygen levels in your blood drop.

If you have plain snoring this can be treated with several medical treatments including medications, surgery, or an oral appliance. You might also benefit from positional therapy. This is where you avoid sleeping on your back. You can use a special pillow or other device. My personal favorite is to take a t-shirt, sew or glue a pocket down the center of the back of the shirt and place 3 tennis balls into the pocket then close it. Every time the person rolls onto their back they become uncomfortable and roll to their side.

If you are not sure if you might have sleep apnea take the Sleep Quiz. If you have a score of 9 or greater than it is time to speak with your physician. Sleep apnea is important to treat because sleep apnea can contribute to many health issues including depression, high blood pressure and diabetes.

If your child is a snorer you should take the time to talk to his or her pediatrician. Sleep disorders can very easily be disguised as irritability, short attention span and can lead to other health problems. It can be caused by enlarged tonsils and adenoids. It can also be caused by a small airway. The current research is discussion new medication treatments to help children.

No matter who in the family is snoring it is something that is not normal. It is something that should be evaluated by a professional. If they can sleep quieter than everyone will get a better night sleep.

There are many CPAP users out there who do not use their machines. Much of this is due to the fact that this type of therapy is requires a strong desire by the user to stick with the therapy. The good news is new masks, machines and humidifiers are making this type of care more comfortable. Several new pieces of equipment are being introduced in the next couple of months.

A new machine is being introduced by Phillips Respironics. This new CPAP, according to the literature, takes care of many of the issues that users tend to have. It has CFLEX, a therapy mode that allows the breath to be delivered similar to a natural breath rather then a machine. This setting also has an adjustment so that the user can find the flow that is comfortable for their personal breathing pattern.

The equipment is also able to communicate with your doctor and medical equipment company. It has a program that will allow them to monitor the progress of the person using the machine and if they are having any issues they can be corrected in a timely manner instead having to wait for a doctor’s appointment and discussing it with them. All the patient needs to do is make a phone call. The doctor of the equipment company can then access the machine and know if it is being used, if the user is still have issues with snoring, apneas, or with the mask and they can then change the setting to help the person be more comfortable.

The final issue they have looked at is proper humidification without the water collecting in the tube. In the old humidifier the temperature was not controlled at the mask. This new machine looks at humidification at the mask so that excess water does not accumulate in the tubing causing a sloshing sound and accidentally drenching the patient as they move during the night.

New masks come out constantly. Phillips Respironics and Resmed have both come out with changes to the masks they offer. Respironics has two new full face masks. The FullLife mask is a restructuring of typical full face mask to make it more comfortable as well as making it lighter. The most unique thing is that it no longer has a forehead pad but has a headgear with a chin strap to adjust the pressure across the bridge of the nose. The Total Face Mask is a mask that seals around the whole face. This allows patients with unusual shaped faces or patients who can not tolerate nasal or full face masks a new option.

Resmed announced they have added a Softgel interface to their line of masks. This will allow for a comfortable fit for patients who need a little more support to their masks.

For people who have had their machines for 5 years or longer many insurance companies will replace older machines, however they may require you to re-qualify by having another sleep study to prove you still have sleep apnea. Mask, hoses, filters and other equipment are replaced every 3 to 6 months but most people have to call their equipment provider to ask for these to be replaced. If a CPAP user wants a new mask most likely they will have to ask their doctor for a new prescription. Masks generally are not interchangeable. Once you choose a mask you must get a new prescription to change it. The same is true for a humidifier. If a person does not get a heated humidifier when they initially get their machine they must get a prescription and may even need another sleep study in order to get one.

Once you have started on CPAP therapy staying current with the changes in equipment may help in keeping a user compliant with care.

Oral devices are one of the least talked about ways to help people with sleep disordered breathing. Because of this lack of discussion there is a great deal of misinformation as to who they work for and what they do.
Sleep apnea and primary snoring can have a profound effect on not only the person who has it but also their bed partner. Loud snoring disturbs sleep and if sleep apnea is present then the pauses and gasps can wake their partner from a sound sleep. When the sleep apnea is mild the option of treating it with an oral device can be quite beneficial.
These small devices come in two varieties. The first one, and the most popular is the mandibular advancement device, it moves the lower jaw forward so that the tongue is advanced and develops more muscle tone and opens the airway. Although there are many manufacturers of these devices the person who should choose which you use and fit you is a dentist who is experienced in sleep disorder dentistry.
The other type of device is best for patients who wear dentures or who have issues that would not allow the jaw to be moved into the proper position. It is called a tongue retention device. It uses suction to pull the tongue forward. This moves it out of the back of the throat and also ads muscle tone to it to help to open the airway.
These devices have several advantages over other treatments. It does not require any surgical procedures. It is small and lightweight making it easy to travel with. It is easier to get used to then some of the other treatment options available.
The drawbacks are that they do not work as well for moderate to severe apnea or where the problem is somewhere other then the back of the throat.
If you have primary snoring, or snoring without any other disorder or you have mild sleep apnea and loosing weight or positional therapy, training yourself not to sleep on your back this might be a solutions. It also might be a good solution for those who do not want to have surgery to fix their snoring problem.
If you want more information on this subject http://www.aadsm.org can provide you with links to doctors in your area accredited to perform medical sleep dentistry.

The new Medicare guidelines require patients to become compliant with their CPAP in 90 days or they will not pay for it. This has some positives and negatives. It now requires the doctors and homecare companies to become more actively involved. The problem is that CPAP sometimes takes a while to get used to. So what do you do when you need to get comfortable in a short period of time?
1. Take your time choosing your mask. If you can afford it get two different styles. The reason being that they place pressure points on different parts of the face. Also they feel different when you wear them. Pillows make the pressure feel stronger where a nasal mask will feel more diffuse. Full face masks are good because you can breathe through your mouth but they leak more.
2. Take advantage of the RAMP feature on most machines. That allows you to decrease the pressure and slowly build while you are falling asleep. This is for comfort and usually rises over 20 minutes to give you time to fall asleep.
3. Humidity is your friend. Many will not use the humidifier because of they do not like their nose to be warm. Humidity will make it more comfortable. Your nose is made to be humidified not dried out. Turn it up so your nose is more comfortable.
4. To follow the humidity, avoid rain out. Put the machine in the draw of the night stand so it is lower then the bed. You can also use some flannel and fabric glue to make a sleeve for the tube.
5. Talk to your doctor and homecare company. If you find that you still can not get used to the machine after a week call the homecare company or your doctor and discuss the problem with them. They should be able to help you find a solution to your problem.

CPAP is a long term therapy for sleep apnea. It takes a little time to get used to. Ninety days is not a lot of time to get used to it but taking advantage of your family, homecare company and doctor will help you to adjust faster.